Provider Demographics
NPI:1013061316
Name:LESKIS, JENNIFER M (AP N)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:LESKIS
Suffix:
Gender:F
Credentials:AP N
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:INCIONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:4885 HOFFMAN BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-3727
Mailing Address - Country:US
Mailing Address - Phone:847-255-9697
Mailing Address - Fax:847-255-3206
Practice Address - Street 1:4885 HOFFMAN BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-3727
Practice Address - Country:US
Practice Address - Phone:847-255-9697
Practice Address - Fax:847-255-3206
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006186363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00617713OtherMEDICARE RAILROAD
IL363062013OtherEIN
IL363062013OtherEIN
ILK41235Medicare PIN